Referring patients to secondary care Interactive MAP Guideline

The MAP Guideline has been developed to help GPs and other primary care healthcare professionals to identify, diagnose and manage infants with CMA in primary care, wherever possible. However, there are times when GPs will need to refer their patients to clinicians in secondary care.

It’s important that GPs know who to refer their patients to, and are able to access the relevant services. The British Society for Allergy & Clinical Immunology (BSACI) website lists NHS allergy clinics that see children and paediatric clinics where there is an expertise in allergy.

If there isn’t a specific service in your local area, patients may need to be referred to another service, such as the general paediatric department at the local district general hospital (DGH). Ideally, all infants and children avoiding cow’s milk from their diet should be referred to a dietitian.

The UK NICE guideline, in agreement with a number of review papers, highlighted the important role of the dietitian in the diagnosis and management of CMA in terms of1:

  • Assisting with taking the allergy-focused diet history
  • Choice of formula
  • Monitoring nutritional status
  • Suggesting nutritional supplements
  • Dietary advice for the breastfeeding mother and infant
  • Providing appropriate weaning advice (this cannot be underestimated)
  • Giving invaluable advice regarding the level of cow’s milk allergen avoidance that is required, i.e. which foods should be omitted and which foods can be tolerated
  • Providing written information on suitable substitute foods, recipes, online information, label reading and life-style adjustments2-4
  • Organising/designing food challenges to diagnose CMA and determine development of tolerance2

1. NICE. Diagnosis and assessment of food allergy in children and young people in primary care and community settings [Online]. 2011. Available at: [Accessed Sept 2013].

2. Venter C, Laitinen K, Vlieg-Boerstra B. Nutritional aspects in diagnosis and management of food hypersensitivity – the dietitians role. J Allergy (Cairo) 2012;2012:269376.

3. Groetch M, Nowak-Wegrzyn A. Practical approach to nutrition and dietary intervention in pediatric food allergy. Pediatr Allergy Immunol 2013;24:212-21.

4. Mehta H, Groetch M, Wang J. Growth and nutritional concerns in children with food allergy. Curr Opin Allergy Clin Immunol 2013;13(3):275-9.